Bill C-14 (Historical)

An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)

This enactment amends the Criminal Code to, among other things,
(a) create exemptions from the offences of culpable homicide, of aiding suicide and of administering a noxious thing, in order to permit medical practitioners and nurse practitioners to provide medical assistance in dying and to permit pharmacists and other persons to assist in the process;
(b) specify the eligibility criteria and the safeguards that must be respected before medical assistance in dying may be provided to a person;
(c) require that medical practitioners and nurse practitioners who receive requests for, and pharmacists who dispense substances in connection with the provision of, medical assist­ance in dying provide information for the purpose of permitting the monitoring of medical assistance in dying, and authorize the Minister of Health to make regulations respecting that information; and
(d) create new offences for failing to comply with the safeguards, for forging or destroying documents related to medical assistance in dying, for failing to provide the required information and for contravening the regulations.
This enactment also makes related amendments to other Acts to ensure that recourse to medical assistance in dying does not result in the loss of a pension under the Pension Act or benefits under the Canadian Forces Members and Veterans Re-establishment and Compensation Act. It amends the Corrections and Conditional Release Act to ensure that no investigation need be conducted under section 19 of that Act in the case of an inmate who receives medical assistance in dying.
This enactment provides for one or more independent reviews relating to requests by mature minors for medical assistance in dying, to advance requests and to requests where mental illness is the sole underlying medical condition.
Lastly, this enactment provides for a parliamentary review of its provisions and of the state of palliative care in Canada to commence at the start of the fifth year following the day on which it receives royal assent.

Opposition Motion—Freedom of Conscience

[Anne Minh-Thu Quach, NDP, Salaberry—Suroît, QC]

—Madam Speaker, I am pleased to speak to the Conservatives' motion today, which states:

That, in the opinion of the House: (a) it is in the public interest to protect the freedom of conscience of a medical practitioner, nurse practitioner, pharmacist or any other health care professional who objects to take part, directly or indirectly, in the provision of medical assistance in dying; (b) everyone has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms; (c) a regime that would require a medical practitioner, nurse practitioner, pharmacist or any other health care professional to make use of effective referral of patients could infringe on the freedom of conscience of those medical practitioners, nurse practitioners, pharmacists or any other health care professional; and (d) the government should support legislation to protect the freedom of conscience of a medical practitioner, nurse practitioner, pharmacist or any other health care professional.

I want to explain why the New Democrats oppose this motion. Throughout the debate on Bill C-14 on medical assistance in dying, the Conservatives have said they are concerned that health care professionals would feel compelled to provide medical assistance in dying to patients, in violation of their personal or religious convictions.

However, the government has clearly indicated, and rightly so, that the bill would not force anyone to provide this service. Although it is not legally necessary to protect freedom of conscience, all of the parties on the Standing Committee on Justice and Human Rights drafted and adopted a compromise amendment, which was proposed by the NDP member for Victoria. The amendment states:

For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.

Another amendment proposed by the NDP member for Victoria was also made to the preamble to ensure that nothing in this act will affect the guarantee of freedom of conscience, religion, and expression, as enshrined in the charter.

Any other additional measure regarding these freedoms would infringe on the provinces' jurisdiction over health because the regulations governing referrals are determined by medical regulatory authorities and professional bodies, not by the federal government's authority over criminal law.

During the discussions in committee about medical assistance in dying, the NDP and almost every party agreed that it was necessary to respect health care workers' personal conscience. We are therefore very proud to have introduced amendments that all parties of the House helped to draft in order to emphasize that there is nothing in this bill that would compel an individual to provide this service or that would infringe on the freedom of conscience, religion, or expression guaranteed by the charter.

The Conservative motion that we are currently debating is asking the federal government to infringe on provincial jurisdiction. I cannot support that. Each level of government needs to respect the others' jurisdictions. By adopting this type of motion, we would not be respecting provincial jurisdiction. Standards of care are established by medical regulatory authorities, not the Criminal Code.

There are a number of factors related to medical assistance in dying that are not included in the bill, and there are also some factors that are included but create vague definitions that were not set out in the Supreme Court's decision.

Throughout my speech, I will explain why it is worrisome that the Liberals are trying to push through Bill C-14 any way they can. Let us start with the process we must follow.

Once again today, during routine proceedings after oral question period, the Minister of Justice rose in the House seeking unanimous consent to debate Bill C-14 for 24 hours, right through the night, some time next week, on the pretext that she wanted to let every parliamentarian speak to the bill.

However, we had already proposed debating Bill C-14 on medical assistance in dying until midnight next Monday, Tuesday, and Wednesday. That is reasonable. It extends the debate and lets parliamentarians do their jobs. They could continue to debate an extremely complex and very sensitive issue on which there really is no unanimity, consult experts, and obtain input from witnesses who appeared and continue to appear before the committee.

The minister rejected sitting until midnight next Monday, Tuesday, and Wednesday. Furthermore, today, on a Friday, a day when not all MPs are necessarily in the House, she is rather aggressively trying to impose another process on the House to force us to sit for 24 hours. Who will watch this debate in the House of Commons at three or five o'clock in the morning? That is completely absurd, and it does not let parliamentarians do a proper job.

The Liberals have already imposed time allocation on Bill C-14, even though they said it was important to take the time to listen to everyone and have a thorough, intelligent debate on the very controversial topic of medical assistance in dying. That completely contradicts what they said when they were in the opposition. Every time the Conservatives invoked closure or tried to cut a debate short or speed it up, the Liberals were the first on their feet in the House to sound the alarm and condemn such undemocratic measures.

Now that the Liberals are in power, they are using the same undemocratic tactics they condemned back then to shut down debate on a very important subject: medical assistance in dying. I cannot believe what I am seeing. They said they wanted to give Canadians change. Now they are forcing us to accept a deeply flawed bill because, they say, they have to get it done by June 6. Experts have criticized the bill because it is not in line with the Carter decision or the Canadian Charter of Rights and Freedoms. This makes no sense.

I want to come back to some of the points that have been raised since the beginning by a number of experts and members of the House, including NDP members. This will open the door to legal challenges because the bill does not comply with the charter and goes against several processes.

I can cite people from the Barreau du Québec. Many experts and stakeholders have shared their concerns. In fact, there is a definition in the wording of Bill C-14 that refers to parts of the bill. That is a problem because the Supreme Court does not use the same language as Bill C-14.

The Supreme Court talks about a person who:

has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

However, the bill talks about “reasonably foreseeable natural death”. That wording does not appear in the Carter decision at all.

Jean-Marc Ménard from the Barreau du Québec said in committee that by adopting a criterion that is more restrictive than what section 7 of the Canadian Charter of Rights and Freedoms allows, the bill would go against the charter. He said, “We should be aware that the impact of the law will in future be measured in light of section 7 of the Canadian Charter of Rights and Freedoms”.

Section 7 is broader in scope than what the bill is proposing, which clearly opens the door to legal challenges. What the Barreau du Québec does not want is for people who could have access to medical assistance in dying under the criteria in the Carter decision to no longer have this access because of Bill C-14, introduced by the Liberals.

That happened in Quebec with a slightly more restrictive criterion. For example, people stopped eating so that they would be eligible under the law. That is serious. Some people who feel extremely desperate about their condition, their situation, and their suffering and who do not have access to medical assistance in dying under Bill C-14 may try to end their life in one way or another just so that they can access the service. That is completely ridiculous.

People mainly want to access this service so that they do not have to suffer anymore. They will inflict greater suffering on themselves so that they can have access to this service, which does not make any sense. The minister does not see that. According to the Barreau du Québec, problems such as that may arise. Earlier, the minister answered a question by saying that there is a diversity of opinions and that she does not think that there will be any court challenges. She is in denial. This is coming from the Barreau du Québec.

I would like to quote some other people. According to the Collège des médecins du Québec, Bill C-14 is unworkable. The secretary of the CMQ believes that it would be far less complicated for Quebec doctors to not have a federal law than to have one. He indicated that the legislative measure that the Liberals hope to pass falls somewhere in a grey area between the Supreme Court's decision and Quebec's law.

Another quote gives me goosebumps. Yves Robert, the secretary of the CMQ, said, “Ultimately, the burden does not fall on the shoulders of legislators. It falls on the shoulders of doctors. They are the ones who are going to have to deal with these cases and these requests.”

Many experts have testified and are still testifying before the committee. They are raising worrisome issues and facts. The minister and the members of the committee examining Bill C-14 are ignoring these opinions but are still claiming that they are making informed decisions that reflect the opinions of most experts and the public's recommendations.

I will now talk about the patients. People who pleaded before the Supreme Court, including the Carter family, are saying that because of Bill C-14, Kay Carter and many people like her would not be eligible since their death is not foreseeable because of their illness. That is what Kay Carter's daughter, Lee Carter, said. It is serious.

The people who fought for this, the pioneers of the bill on medical assistance in dying, argued their case before the Supreme Court and won. However, we are taking a step backward. Those people who won their case in the Supreme Court will likely be denied this care by the Liberal government, which is not listening to the advice of experts or ensuring it upholds the Supreme Court ruling.

Another very troubling point is the lack of funding for palliative care.

During the election campaign, the Liberals promised to invest $3 billion in palliative care, end-of-life care, and home care. However, these investments were nowhere to be found in their budget, nor are they in Bill C-14 on medical assistance in dying.

All the Liberal members who have spoken in the House have recognized that we need to work on a long-term strategy to ensure that patients have access to good-quality, long-term palliative care, and to ensure that all those who want to continue living with a decent quality of life are able to do so.

For this to happen, we need more than words. We need investments and a plan. However, we are not seeing any of that. As of today, May 13, 2016, the bill is still in committee. It will soon return at third reading, and the government has yet to propose anything. So far, it has invested zero dollars in palliative care. That is very worrisome. I remind members that our population is aging. More and more people will have serious illnesses and will be experiencing unbearable suffering, and the Liberal government has still not proposed any significant measures to address this.

In 2014, my colleague from Timmins—James Bay moved Motion No. 456, which was about a pan-Canadian palliative and end-of-life care strategy, and that motion was passed. The Liberals voted in favour of the motion to implement such a strategy.

The motion said that the government should work with the provinces and territories to develop a flexible, integrated model of palliative care that takes into account the geographic, regional, and cultural diversity of urban and rural Canada as well as Canada's first nation, Inuit, and Métis people and respects the cultural, spiritual, and familial needs of all Canadians.

The model would also have had the goal of ensuring that all Canadians have access to high-quality home-based and hospice palliative and end-of-life care, providing more support for caregivers, improving the quality and consistency of home and hospice palliative and end-of-life care in Canada, and encouraging Canadians to discuss and plan for end-of-life care.

The Liberals supported this motion. Then how is it that the Liberal government did not announce a specific and real investment in its budget or in committee after discussing medical assistance in dying with the experts? This is actually a very important bill. We have to accommodate as best we can people at the end of life who are suffering. It is completely unacceptable and irresponsible for the government to not have included a plan in the bill.

Nevertheless, we are pleased to have made an amendment to Bill C-14, which will protect the individual's right to freedom of conscience and secure a much greater commitment to palliative care, mental health, dementia, and services to indigenous patients. However, the money must be made available. Writing words on a bill is not enough. Investments are needed in order to implement a palliative care strategy.

Moreover, we must work in a non-partisan manner. The Liberals must open their eyes and realize that their bill is deeply flawed. Their bill could give rise to a thousand and one legal challenges because they are trying to push it through and are not considering the opinions of experts. The experts who returned to committee repeated what they said the first time. It is a waste of time and money.

The NDP is asking the Liberals to refer their bill to the Supreme Court to ensure that it is constitutional and thus prevent countless legal challenges. The Liberals are refusing to do this. What are they afraid of? Whey are they refusing to refer their bill to the Supreme Court if they are so sure that everything is just fine and dandy?

I hope that the Liberals will eventually listen to reason.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Madam Speaker, on a point of order, I believe we are still debating the opposition motion. I think the member is asking about Bill C-14, not about the opposition motion or conscience at all.

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

Madam Speaker, with respect to our country, Bill C-14, medical assistance in dying, is a transformation in terms of our thinking and in terms of the discussion around medical assistance in dying. We have had the opportunity to engage with a diversity of opinions, a diversity of expert opinions and individual Canadians right across this country.

I received in my office thousands of letters and engagements on this particular issue. There is always going to be a diversity of opinions on both sides.

The opportunity and the challenge presented to parliamentarians is to ensure that we put forward the best solution, the best balance, in terms of this really difficult issue. I am confident that Bill C-14 responds to the Carter decision of the Supreme Court of Canada and is compliant with the charter.

[Anne Minh-Thu Quach, NDP, Salaberry—Suroît, QC]

Madam Speaker, a number of experts such as representatives of the Barreau du Québec and the Canadian Bar Association, as well as people who intervened in the Carter case, are saying that there will be several legal challenges to the minister's Bill C-14 on medical assistance in dying, that it violates the Canadian Charter of Rights and Freedoms, that there will be more medical and legal problems, and that many people will not have access to medical assistance in dying services. What are the minister's thoughts on that?

The recommendations made by a number of experts were not accepted. It is very worrisome to see that the Liberal government is hurrying the debate in this manner when there are still many outstanding issues that are not being considered.

[Jody Wilson-Raybould, Liberal, Minister of Justice and Attorney General of Canada]

Madam Speaker, I thank the hon. member for the question and for participating at the committee.

The Civil Marriage Act has been raised a number of times in this House today. I will speak to the Civil Marriage Act in terms of the specific provisions, which referred to specific religious officials and the performance of private functions. We are talking about medical assistance in dying, which is a public general function.

I will say that I embraced the discussions that happened at committee. There were 16 thoughtful amendments proposed. There is nothing in Bill C-14 that would compel a medical practitioner to perform medical assistance in dying. Of the amendments that were made, two of them inject conscience rights into the preamble, and as well within the legislation itself.

Health

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Mr. Speaker, if that is true, that the government cares about palliative care, it should have told its members on the justice committee.

This week the justice committee shot down almost all opposition amendments on Bill C-14, including this one, “[that if someone] consulted a medical practitioner regarding palliative care options and were informed of the full range of options”.

Can the minister explain why Liberals shot down a very modest amendment requiring that patients simply be informed about palliative care options?

Opposition Motion—Freedom of conscience

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

Mr. Speaker, this is a deeply personal and complex issue, and we have sought to move forward and introduce Bill C-14, a piece of legislation that provides what we believe to be the best option for our country at this time. We have heard from a diversity of perspectives.

The object of this piece of legislation is in response to the Supreme Court of Canada's decision that said two things: one, that an absolute ban on medical assistance in dying in this country is unconstitutional; and, two, it placed upon Parliament the necessary ability and direction that Parliament put in place, a regime that ensures that we protect the personal autonomy of individuals while at the same time ensuring, as much as we can, protection for the vulnerable people among us. This also includes ensuring the conscience rights of medical practitioners.

We have put forward a bill that seeks to do that and that provides the necessary balance and response to the Supreme Court of Canada.

[Linda Duncan, NDP, Edmonton Strathcona, AB]

Mr. Speaker, I thank the minister for attending and participating.

However, I think the minister is misleading the House. She stated that Bill C-14 enables autonomy and access to the majority of those requesting the right to assistance in death. In fact, the bill excludes a whole category of persons, including my constituent, John Tuckwell, who is suffering immeasurably under ALS and has been forced to go to the courts to get assistance in dying.

I wonder if the minister could qualify what she is saying about the majority who are seeking this assistance, who are suffering grievously, according to what the Carter decision has said, and why she is varying the section 7 charter rights of Canadians.

[Jody Wilson-Raybould, Liberal, Minister of Justice and Attorney General of Canada]

Mr. Speaker, I rise in this House to address the opposition motion concerning the conscience rights of health care professionals.

The motion directly relates to Bill C-14, a historic piece of legislation that would create a legislative framework governing the provision of medical assistance in dying.

I call this legislation historic because with its enactment, Canada would not only become one of the first jurisdictions in the world to permit medical assistance in dying, but also, even among this small group of countries, we would be one of the first that does so in the context of a federal system of government.

I am mindful of how important the issue of conscience rights is to health care professionals, as well as many groups who have made representations on their behalf.

In the Carter case, many of the intervenors who participated in the litigation raised the issue of conscience rights, including, as noted by the Supreme Court of Canada in paragraphs 130 and 131 of its decision, the Canadian Medical Association, the Catholic Civil Rights League, the Faith and Freedom Alliance, the Protection of Conscience Project, and the Catholic Health Alliance of Canada.

As the Supreme Court said clearly in its decision, nothing in the court's declaration would compel a physician to provide medical assistance in dying.

Following the Carter decision, the theme of conscience rights featured prominently in the consultations conducted by the federal external panel. Many individuals and organizations made submissions and participated in this process to ensure their perspectives on conscience rights were heard.

The panel's final report noted that while the medical profession is divided on how exactly conscience rights should be protected without compromising patient access, stakeholders were unified in the view that physicians' and other health care professionals' conscience rights must be respected and that those who choose not to participate must not face negative repercussions.

The report of the provincial and territorial expert advisory group which was released in December of last year shows that it also received significant input about, and carefully considered, the conscience rights issue.

When the special joint committee of the House of Commons and the Senate conducted its own study of medical assistance in dying in January and February of this year, conscience rights continued to be front and centre. Numerous witnesses raised it, and the issue was addressed in the committee's report.

Following the introduction of Bill C-14, I have closely followed the Standing Committee on Justice and Human Rights' study of the proposed legislation, as well as the Senate's pre-study, which have both heard significant evidence from many people and organizations about conscience rights.

For example, I am mindful that the House of Commons committee stakeholders were from various diverse backgrounds who held a broad spectrum of views on medical assistance in dying generally supported conscience rights. Individuals and organizations motivated by their faith traditions, including the Evangelical Fellowship of Canada, the Canadian Council of Imams, the Centre for Israel and Jewish Affairs, and Cardinal Thomas Collins all spoke eloquently about why the legalization of medical assistance in dying, which is intended to respect the charter rights of eligible patients, should not have the uncomfortable consequence of violating the charter rights of health care professionals.

Representations from professional organizations, such as the Canada Medical Association, the Canadian Pharmacists Association, the Canadian Society of Palliative Care Physicians, and the Canadian Medical Protective Association also emphasized the need for conscience rights protections not only through legislative measures, but also via a system that would ensure that the patient is not abandoned in his or her hour of need, and would connect the patient with willing providers.

Not everyone agrees on all issues that are posed in medical assistance in dying; however, there is general consensus that the conscience rights of health care practitioners must be taken into consideration as we introduce this practice into our society.

As the Minister of Justice and Attorney General of Canada, I want to express my sincere appreciation to each and every one of these persons and groups, as well as the members in this House who have been so vocal on the issue of conscience rights for contributing to a national conversation on medical assistance in dying.

I am keenly aware that it takes significant time, energy, and effort to prepare and present submissions, whether it is before the courts, consultative bodies, or committees. Rest assured their voices have been heard.

In a moment I will turn to the issue of how the government's approach to medical assistance in dying reflected in Bill C-14 respects the conscience rights of health care professionals and respond to the member opposite's motion.

First I want to take the opportunity to say a few words about the bill and how it respects all rights guaranteed under the charter, including conscience rights. I will say more about this when the bill is reported back by the committee for third reading debate.

At the Standing Committee on Justice and Human Rights as well as in the Senate as part of the legal and constitutional affairs committee's pre-study of the bill, parliamentarians heard from some who have expressed concerns that Bill C-14 falls short of complying with the charter. At the same time, we have also heard from other constitutional experts who have said that given the recent developments in the law, the bill is charter and Carter compliant.

Given all these diverse opinions, the key takeaway here is that nobody has a monopoly on interpreting the charter and nobody can predict with certainty whether a piece of legislation will some day be considered by the courts. Furthermore, many of those who seem certain that this law will be struck down do not acknowledge that Bill C-14 is not the same as the previous criminal prohibition that was struck down.

Let me be clear. This proposed legislation permits medical assistance in dying to an overwhelming number of those who are expected to seek it, namely, those who are nearing or who are at the final stage of life. Data from places where assistance in dying is lawful bear this out. Make no mistake that Bill C-14 would provide access to the vast majority of Canadians who would seek to access it.

At the same time that Bill C-14 permits access to the majority of those who would want it, it would not allow any and all Canadians to access it. It limits access in accordance with the legislative objectives that are stated in the preamble of the bill. These new legislative objectives were not part of the old law. Accordingly, the new legislative objectives change the charter analysis which has not been acknowledged by those who say that Bill C-14 will be struck down.

Even the justices of the Supreme Court themselves cannot pronounce on the constitutionality of legislation until they have a real case before them that is supported by a fulsome evidentiary record and submissions from counsel. This is especially true on issues as complex and sensitive as medical assistance in dying with so many different compelling, competing and important interests.

At the end of the day, the responsibility rightly falls to Parliament to enact a law that is consistent with the charter and which meets the needs of Canadians, striking a fair balance between all the diverse interests that are at stake. As the Supreme Court stated in Carter, any legislative regime will be shown a high degree of deference by the courts. In the context of medical assistance in dying, conscience rights raise distinct and nuanced constitutional issues.

First and foremost, it is critical to note that since the repatriation of the Constitution in 1982 and the enactment of the Charter of Rights and Freedoms, all statutes, whether they are adopted at the federal or provincial and territorial levels, must comply with the charter.

Indeed, as trite as it sounds, we must remember that charter rights do not come from provisions in a given law or regulation. They come from the charter itself. Nothing is gained by having an ordinary statute confirm or affirm charter rights. It is a recognized principle of statutory interpretation that courts should endeavour to interpret and apply laws in a manner that is consistent with the charter and its values.

Whether or not Bill C-14 or any other legislation that is proposed says something specific about charter rights, including conscience rights, it does not mean that such rights are not protected. On the contrary, as the charter is part of our Constitution and the supreme law of the land, such rights are always protected and can only be limited in accordance with the Constitution, such as under section 1 of the charter which allows for reasonable limits that can be demonstrably justified in a free and democratic society.

Therefore, strictly speaking, legislation does not need to restate rights that are already guaranteed in the Constitution, and nothing is gained in terms of charter protections by restating it from a legal point of view. However, in terms of public understanding, I do appreciate that legislative statements referring to charter rights can alleviate the comfort level of those who are affected by the law. I will say more about that in a moment.

Second, but equally important, legal consideration that informs how we must approach conscience rights is the other pillar of our constitutional framework, which has been with us since Confederation. Of course, I am referring to the division of powers between the federal and provincial governments.

When it comes to medical assistance in dying, the Supreme Court of Canada in Carter recognized that the division of powers was implicated when it said, in paragraph 53:

Health is an area of concurrent jurisdiction [and that] aspects of physician-assisted dying may be the subject of valid legislation by both levels of government, depending on the circumstances and the focus of the legislation.

In other words, while health might be, broadly speaking, an area of concurrent jurisdiction, the specific context still matters.

With respect to medical assistance in dying, the major federal authority to legislate in respect of health comes from the criminal law power. That power is concerned with preserving public safety as well as conveying norms about what conduct should attract the most serious sanctions available in our society.

In respect to medical assistance in dying, the main federal role is to ensure that legalization of the practice takes place in a manner that minimizes the risks to the vulnerable and that supports other crucial societal objectives, such as affirming the inherent value of all Canadians' lives, supporting suicide prevention, and promoting the maintenance of a just and peaceful society more generally. This is why Bill C-14 creates criminal law exemptions for medical assistance in dying so that health care providers can lawfully participate in the termination of human life while maintaining criminal prohibitions against such conduct in other situations.

In contrast, while the federal government administers some aspects of health care, for example, to first nations who have not assumed responsibility on reserve, and federal prisoners, provinces have primary responsibility for the delivery of health care and the regulation of professions, including health care professionals, such as physicians, nurses, pharmacists, and others. They also have responsibility for health care institutions, including hospitals. This is because things fall under matters either specifically addressed in section 92 of the Constitution Act of 1982, or are in respect of other provincial heads of power, including matters of a local or private nature in a province.

Federal laws, including amendments to the Criminal Code and other statutes, as proposed in Bill C-14, must respect this division of powers and not unduly interfere in provincial jurisdiction. To do so would be unconstitutional. It is for this reason that we as parliamentarians must be honest with Canadians about the limits of our jurisdiction and acknowledge that it would not be appropriate, for example, to attempt to directly regulate what hospitals or provincial professional regulators can or cannot do with respect to conscience rights. To do so would be misleading to health care providers and to Canadians.

With that said, this does not mean that we cannot address conscience rights in Bill C-14. It just means that we have to do it in a manner that respects the Constitution.

As introduced, the preamble of Bill C-14 included language about respecting the convictions of health care providers. However, it was obvious that many people did not find that reference in the preamble to be adequate and were seeking more precision.

Of course, our government wants all Canadians to have comfort, as much as they can, with Bill C-14. Therefore, I am pleased to report, as has been reported today, that members of the Standing Committee on Justice and Human Rights worked diligently and collaboratively to amend Bill C-14 to indicate Parliament's intent with respect to conscience rights, while also ensuring compliance with the division of powers.

The committee amended the preamble to specifically recognize that everyone has freedom of conscience and religion under section 2 of the charter and that nothing in the act would affect the guarantee of freedom of conscience and religion. The committee also amended the body of the bill so that in the most critical section of the Criminal Code, that law would state, “For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.” I certainly welcome these amendments.

There are a few important features of the amendment to the body of the bill that I believe are worth highlighting.

First, it is prefaced with the expression “for greater certainty”, which is legally important because, as I mentioned earlier, it helps remind the reader that the source of conscience rights is in the charter, not the provision that would be inserted in the Criminal Code.

Second, the new provision explains that nothing compels an individual. That language clearly communicates that while it is true that Bill C-14 would remove the criminal prohibition against medical assistance in dying in certain defined circumstances, such a change to the Criminal Code would not impose any positive duty that did not exist in the law before. It is not this change to the Criminal Code that would make medical assistance in dying a form of health care. It would only open the door to it. It is also consistent with the framework for medical assistance in dying put forward in Bill C-14, which is, as I have mentioned, a new set of criminal law exemptions from various offences that would now permit conduct that used to be illegal, in order to give effect to the Supreme Court's ruling in Carter. We must remember that what the Carter ruling did was to find those criminal prohibitions to be unconstitutional.

Third, the language in the new provision specifically indicates that nothing would compel an individual to provide or participate in providing medical assistance in dying. As all members are aware, charter rights belong to all Canadians, not just physicians, nurse practitioners, or pharmacists. By using the word “individual”, the provision is clear that the bill would not impose any new positive duty on anyone, including but not limited to those health care professionals who provide or participate in providing medical assistance in dying. At the same time, this new provision added by the committee would not interfere with the division of powers, nor would it encroach on the jurisdiction of provincially regulated entities.

In terms of working together, since the Carter decision, one thing that we have consistently heard from many individuals and organizations who have spoken about conscience rights is the need for there to be real, practical solutions to the problem of palliative care. The Minister of Health has emphasized, and I agree with her, that non-legislative measures can act in tandem with Bill C-14 to ensure the charter rights of everyone involved, and that they can be respected.

This is why the government has announced its commitment to work closely with the provinces and territories to put in place a system that will connect willing providers to patients who qualify for medical assistance in dying. This is in line with the long-standing Canadian tradition of co-operative federalism, which is about each level of government working together while also respecting their respective jurisdictions. I am confident that this system will meet the access needs of Canadians and play an important role in ensuring that health care professionals can continue to care for their patients in a manner that is consistent with their beliefs and their values.

The motion from the member opposite is well intentioned. It speaks to rights and values that are important to many Canadians, particularly as they pertain to medical assistance in dying. However, I cannot support it. As amended, Bill C-14 would appropriately respond to all the important considerations that surround medical assistance in dying, including enabling autonomy for persons who choose a peaceful death, protecting vulnerable persons, affirming the value of the lives of all Canadians, and respecting the charter rights of health care professionals. The bill would respect these rights in a manner that is consistent with our constitutional framework. Unfortunately, the motion from the member opposite would fail to meet a similar balance, and I will not be supporting it.

[Richard Cannings, NDP, South Okanagan—West Kootenay, BC]

Mr. Speaker, I would just like to ask the member what she might think about the charter compliance of Bill C-14, which we are talking about today, the compliance with the Supreme Court decision, and whether it might save a lot of taxpayer money if the government referred the bill directly to the Supreme Court.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Mr. Speaker, I am speaking today to compel the House to ensure the protection of the freedom of conscience of a medical practitioner, nurse practitioner, pharmacist, or any other health care professional who objects to taking part, directly or indirectly, in the provision of medical assistance in dying.

I would like to introduce everyone to Os Guinness, an author, a social critic, and a member of RZIM speaking team. The great-great-great-grandson of Arthur Guinness, the Dublin brewer, he was born in China in World War II, where his parents were medical missionaries. A witness to the climax of the Chinese revolution in 1949, he was expelled with many other foreigners in 1951 and returned to Europe, where he was educated in England. He completed his undergraduate degree at the University of London and his doctorate in philosophy in the social sciences at Oriel College in Oxford. I say that to give him the credibility he deserves.

He has said, “Freedom of conscience has always been understood as the first right”. In a world ravaged by conflict, there is real threat to human dignity. Dr. Guinness proposes that the way forward is through engaging in the civil public square, where freedom of conscience and religion are promoted for all people, where we can disagree respectfully, where the right to free expression by all human beings is recognized.

In Canada, everyone has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms. No one has the right to demand all services from all providers in all circumstances.

The Coalition for HealthCARE and Conscience represents more than 100 health care facilities, with almost 18,000 care beds and 60,000 staff, and more than 5,000 physicians across our country. They represent several like-minded organizations committed to protecting conscience rights for health practitioners and institutions.

Members of this coalition include the Catholic Archdiocese of Toronto, the Christian Medical and Dental Society of Canada, the Catholic Organization for Life and Family, the Canadian Federation of Catholic Physicians' Societies, the Canadian Catholic Bioethics Institute, Canadian Physicians for Life, and the Catholic Health Alliance of Canada. I echo their concern that Bill C-14 does not protect the conscience rights of health care workers or facilities that morally object to performing or referring for what is being referred to as medically assisted death.

No other foreign jurisdiction in the world that has legalized euthanasia or assisted suicide forces health care workers, hospitals, nursing homes, or hospices to act against their conscience or mission or values. Coalition member and executive director of the Christian Medical and Dental Society of Canada Larry Worthen says, “These conscience rights must be preserved”, and I agree.

A recent Nanos Research poll found that 75% of Canadians agree that doctors should be able to opt out of offering assisted dying, compared to 21% who disagree. The Canadian Medical Association indicates that approximately 70% of Canadian physicians do not want to participate in any way in assisted death and euthanasia, and 30%, approximately 24,000 Canadian physicians, would participate.

In no way should a physician, nurse, pharmacist, or any other health care professional be intimidated or coerced into taking part directly or indirectly in assisted suicide or euthanasia. In the same way, neither should they face dismissal or discrimination in hiring for exercising their freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms.

Like the Coalition for HealthCARE and Conscience, I support the right people have to accept, refuse, and/or discontinue the use of life-sustaining treatment and allow death to occur. I, too, also hold strong moral convictions that it is never justified for a physician to help to take a patient's life under any circumstances. Our health care workers journey with those who are sick and suffering every day and they will continue to do so in a caring and compassionate way. They help patients at the end of life. What they object to is ending their lives.

As I indicated in my first speech in the House of Commons on Bill C-14, we need to and can significantly reduce the number of people who see death as the only possible option to end their suffering by improving medical, palliative care, and social services. As a small but mighty example, I learned at the World Red Cross Day celebration here on the Hill that my local Red Cross received ongoing funding to continue a seniors visitation program for the lonely and elderly through the new horizons for seniors program. When they are not called out to deal with a disaster, these amazing volunteers invest in the quality of life of our elderly.

“Our worth as a society is measured by the support we give to the vulnerable,” says Worthen. “We need increased access to palliative care, chronic disease and mental health services to help individuals who are suffering across the country.”

I truly believe that we have made a very grave error in putting Bill C-14 ahead of a significant palliative care initiative.

I am proud to stand here today, on behalf of my own physician in my hometown of Esterhazy. She is an amazing doctor who takes deep personal interest in her patients. She has invested in continued and specialized training to care for the elderly. I am so grateful that she is my father's physician, who has Alzheimer's. Under no circumstances should she, or any other doctor, be required to assist an individual in taking their own life.

I am standing here today, as a member of Parliament in the Government of Canada, to advocate on behalf of the rights of health care providers. As legislators, our first responsibility is to advocate for the vulnerable and for conscience protection. This is foundational in the Canadian Charter of Rights and Freedoms. Without this protection, we lose our freedoms and our democracy. We have a responsibility to respect the conscience rights of our physicians and health care professionals who choose not to participate in assisted suicide and euthanasia.

[Sean Casey, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Mr. Speaker, the member who proposed the motion was present at many of the hearings of the justice committee on this matter. The original draft of Bill C-14 did not have any reference to conscience rights, except in the preamble.

Each party had a proposal to put wording around conscience rights, and quite frankly, it was Parliament at its best to see representatives of the Conservative Party, the New Democratic Party, and the Liberal Party huddle and come up with wording upon which they could all agree.

That wording has been amended in the bill, and here we are with an opposition day motion that seeks to subvert that all-party agreement by presenting a motion like this in Parliament. Furthermore, that all-party agreement resulted in a unanimous vote amending the legislation, as the hon. member pointed out.

I have two questions for the member. Number one, why does he seek to subvert the will and the agreement of the Conservative members of the justice committee? Second, when the department was asked about this particular provision, Joanne Klineberg from the Department of Justice said:

...the view of the department is that this would be outside [the scope of] Parliament's jurisdiction. The provinces have the competence jurisdictionally to legislate on this, and likely it would be invalid federal law.

Does the hon. member have an opinion contrary to that of the Department of Justice that would give us some faith in this?

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Mr. Speaker, I will be splitting my time with the member for Yorkton—Melville.

I am thankful for this opportunity to speak to the motion before us today. The motion declares that it is in the public interest to protect the freedom of conscience of health care professionals when it comes to medical assistance in dying; and that everybody has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms; and that a regime that would require health care professionals to make use of effective referral of patients could infringe on the freedom of conscience; and that the government should support legislation to protect the freedom of conscience of health care professionals.

It is the federal government's duty to provide legislation that would protect conscience rights of medical practitioners. With respect to the rights of Canadians, it is also the government's duty to protect and preserve our health care system.

Fundamental freedom of conscience is listed alongside other fundamental freedoms we also take for granted here in Canada, such as the freedom of religion, freedom of thought, freedom of belief, freedom of expression, freedom of the press, freedom of peaceful assembly, and freedom of association. Fundamental freedoms are not negotiable. They cannot be tossed aside if they are deemed by some to be inconvenient. Canada is not a dictatorship or a tyranny.

I know from comments made in the House and at committee that all members here are concerned about conscience rights. When Parliament has been faced with balancing conscience rights in the past, it has always strongly supported conscience rights. For example, in the Civil Marriage Act, it clearly states “no person or organization shall be deprived of any benefit, or be subject to any obligation or sanction” when exercising their fundamental charter rights of freedom of conscience.

We can establish a framework that supports patient rights for end of life and supports conscientious objection. The problem is that Bill C-14 would not legally protect conscience rights. If Bill C-14 comes into force, it would immediately put the charter conscience rights of health care professionals at risk and ultimately undermine our health care system.

The government will argue that Bill C-14 was amended at justice committee this past week to prevent health care professionals from being compelled to participate in medical assistance in dying. The amendment made at committee states, “For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying”.

Let me be clear. The amendment made at the standing committee to Bill C-14 offers no legal protection to health care providers who feel that any involvement in medical assistance in dying goes against their conscience and their profession.

Just because Bill C-14 presently states that nothing in this specific section of the Criminal Code can compel health care professionals, it does not mean that any other entity still cannot compel or coerce a health care provider against his or her conscience rights. For example, an employer could insist upon it or a provincial health care regulatory body could as well.

Health care professionals have been clear that protecting their conscience rights means that health care professionals should never be required to refer patients, provide medical assistance in dying, or be discriminated against for their beliefs or conscience on medical assistance in dying.

During the Supreme Court of Canada hearings on the Carter case, the Canadian Medical Association expressed that “any legislative scheme must legally protect both those physicians who choose to provide this new intervention to their patients, along with those who do not”. Bill C-14 does not offer legal protection.

At committee, Conservatives put forward strong amendments to legally protect health care professionals' conscience rights and they were rejected by the government.

If Bill C-14 passes without legal protections for health care providers' conscience rights, Canada would be the first jurisdiction in the world that legalized assisted suicide without a robust conscience clause for health care providers.

It is also important to recognize that without federal government direction on conscience rights, Canadians and health care professionals would be faced with a patchwork approach, which is not what the Supreme Court of Canada intended. For example, the College of Physicians and Surgeons of Ontario is insisting on an effective referral system. This poses an immediate problem for those doctors who are conscientious objectors and are forced to choose between a career and conscience when this legislation comes into effect.

On Wednesday the Senate heard testimony from the Coalition for HealthCARE and Conscience, an organization and coalition that represents 5,000 physicians, 110 health care facilities, and 60,000 staff in the health care profession.

They expressed grave concern that Bill C-14 offers no legal protection for conscience rights of health care professionals. They were concerned that health care professionals might re-evaluate their career choice.

They stated:

Through our discussions with the provinces, we know that it is unclear whether, in fact, they will decide to legislate. In this legal vacuum, hospitals, colleges, provinces, health authorities, nursing homes and hospitals can create policies that will encroach on the constitutional rights of caregivers. This will create chaos. For example, while one medical college, the CPSO, is requiring referral, at least seven others have already indicated they will not.

It is clear that a patchwork approach to issues like referrals and medical assistance in dying will take place. It is within this legal vacuum that health care professionals will face discrimination, because Bill C-14 would not legally protect conscience rights. This type of situation would not only harm a society but would also harm a health care system. Health care professionals expressed that they would have to make the difficult decision to leave their profession if we fail to protect freedom of conscience rights.

Dr. Sephora Tang, who is an Ottawa psychiatrist, shared with the Senate committee on Wednesday her concerns about the lack of protection in Bill C-14.

She stated:

It is very difficult for me, as a professional physician and psychiatrist, to say that some of my patients I should be referring to medical aid in dying.... With the whole issue of conscientious objection, it's almost as though my professional judgment has been stripped.... If we do not have legislation that allows me to practice according to my conscience, this time that I have with my patients to work with them will be truncated, and I feel to their detriment and to the detriment of the families and friends of the patient that are left behind, and also to the individual health care professionals and the team members who work with this patient as well.

Dr. Matthew Meeuwissen, an emergency doctor from Stony Plain, Alberta, also expressed this opposition to medical assistance in dying. He said that the act of helping a patient to find a physician to assist in suicide is nothing short of complacency in killing vulnerable people. He said, “As a physician, I am not aware of any medical condition where killing my patient is an effective treatment”.

There are many more health care professionals who hold similar views and face ultimately between choosing for their conscience or their work. These health care professionals journey with those who are suffering and sick every day. They help patients at the end of life but object to ending their life.

The Hippocratic Oath rightly recognizes this element of our nature. Health care professionals take an oath stating they will remember that there is art to medicine as well as some science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

Freedom of conscience for all health care professionals must be protected. Hope, a constituent in my riding, sent me an email recently stating:

Conscience Rights are a protected freedom under the Charter of Rights and should NOT be violated. Saying this it should be clearly stated that healthcare providers can refuse to perform or refer for physician assisted suicide on the grounds of conscientious objections. Do not trammel the rights of one group for the perceived rights of another.

A majority of Canadians agree with Hope. A recent Nanos Research poll showed that 75% of Canadians agreed that doctors should be able to opt out of offering assisted dying, compared with 21% who disagreed. Even the Canadian Medical Association noted that approximately 70% of Canadian physicians do not want to participate, directly or indirectly, in assisted suicide.

Freedom of conscience rights must be given a priority, as in the charter. The government should strengthen Bill C-14 by adding codified protections for conscience rights as anticipated in Carter, similar to the recognition of conscience and religious rights in the Civil Marriage Act. This would be accomplished by adding an offence to intimidate or coerce health care professionals to take part, directly or indirectly, in assisted suicide or euthanasia.

The government should also make it an offence to dismiss from employment or to refuse to employ health care professionals if they refuse to take part, directly or indirectly, in assisted suicide or euthanasia.

If freedom of conscience rights for health care professionals is not protected, the rights of a few will trample the charter rights of those who have dedicated their lives to helping us heal and live healthy lives.

I hope the government will support this motion and ultimately act to legislate real protection for health care professionals on medical assistance in dying.

[Gord Brown, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Mr. Speaker, I would like to say that we would support more time to debate Bill C-14, but we ask to amend the motion that the members sit no later than midnight, at which time the House would adjourn.

Business of the House

[Dominic LeBlanc, Liberal, Leader of the Government in the House of Commons]

Mr. Speaker, this afternoon, we will continue with the Conservative opposition day. Tomorrow will be a further allotted day. Monday, we will begin report stage and third reading stage of Bill C-10 concerning Air Canada until 2 p.m. After question period, we will move on to Bill C-14 concerning medical assistance in dying.

I have had productive and optimistic discussions with my colleague House leaders. I am hopeful and optimistic that we will have an agreement on the handling of the debate at report stage and third reading of Bill C-14 next week.

Provided we are able to complete debate on Bill C-14 next Wednesday, the House will debate an NDP opposition motion on Thursday.

Finally, pursuant to Standing Order 81(4), I would like to designate Monday, May 16, for consideration in a committee of the whole of the main estimates for the Department of National Defence.